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It is relevant to note that, in three studies [47, 54, 57], a reduction in neutropenia was observed in smokers, suggesting a reduced toxicity on blood cells, which could also lead to a reduced toxicity on neoplastic cells, with a consequent reduction in the anti-tumor effect of the drug, increasing the probability of failure of therapy

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The study limitations include the inability to capture malformations in pregnancies that do not result in a live birth, and possible misclassification of outcome and of exposure to varenicline or to smoking

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Contrarily, another study examining sibling-pairs discordant for maternal smoking during pregnancy ( n = 1,538) found that PTE had no apparent influence on tobacco dependence in adulthood [159]